Provider Demographics
NPI:1639358658
Name:ITANO DENTISTRY
Entity Type:Organization
Organization Name:ITANO DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SADAO
Authorized Official - Middle Name:
Authorized Official - Last Name:ITANO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-795-7698
Mailing Address - Street 1:90 N HUDSON AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-1808
Mailing Address - Country:US
Mailing Address - Phone:626-795-7698
Mailing Address - Fax:626-795-2116
Practice Address - Street 1:90 N HUDSON AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-1808
Practice Address - Country:US
Practice Address - Phone:626-795-7698
Practice Address - Fax:626-795-2116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-26
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12560261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental